Monday, June 9, 2008

Radiology of Competitive Speed Eating

We all eat to live. Most of us also eat for enjoyment. Many of us overeat for various reasons. A very few of us overeat as a competitive sport.

What's in it for the winners? For the eliter eaters, one can earn an annual 5-figure income. Plus, if you don't mind eating on the Anaconda Plan (Eat the Whole Pig. Right Now.), there's all that free food at the contests.

What does it take to choke down chow at a world-class pace? There seem to be many ninja tricks to help one really scamper while scarfing scads of scoff. Lubricating hotdog buns with water is one technique, and others polish off the Polish two at a time to increase their rate of input.

However, on an anatomic and physiological basis, there are only a few logical ways to explain the capacity of some supreme suppers:

increased stomach size

increased gastric emptying speed into the small intestine

disappearance of food into the fourth dimension

Of the possibilities listed above, scientists are pretty darned sure that no. 3 is definitely not the explanation. Beyond that, we don't know the whole story. However, a recent fluoroscopic study by Levine et al from the University of Pennsylvania sheds some light on ins and outs (well, mainly ins) of marathon munching.

The purpose of our investigation was to assess the stomachs of a world-class speed-eating champion and of a control subject during a speed-eating test in our gastrointestinal fluoroscopy suite to determine how competitive speed eaters are able to eat so much so fast.

They did this by pitting a large burly control dude (6 ft 2 in / 210 lb aka 188 cm / 95 kg) with a hearty appetite against a slender subject (5 ft 10 in / 165 lb aka 178 cm / 75 kg) who just happened to be ranked among the top 10 competitive speed eaters in the world by the IFOCE.

After a few preliminary tests, these two subjects were asked to eat as many hot dogs as they could. The big burly dude ate 7 before feeling uncomfortably full. The champion eater then proceeded to down 2 dogs at a time for the next 10 minutes. After he ate 36 hotdogs, the investigators terminated the experiment.

Despite the speed eater’s insistence that he felt no sensation of satiety, fullness, bloating, or abdominal discomfort, we became concerned that further dilation of his already enormous stomach could be associated with a small theoretic risk of gastric perforation. Therefore, a decision was made to terminate the speed-eating test over the objections of our participant.

While all of this was going on, the radiologists asked the eaters to also ingest a barium sulfate solution so they could watch the stomach under fluoroscopy. The control dude's stomach showed a large mass of partially chewed hotdog bits, but only minimal gastric dilatation. The eating champion looked a bit different:

His stomach now appeared as a massively distended, food-filled sac occupying most of the upper abdomen, with little or no gastric peristalsis and emptying of a small amount of barium into the duodenum.

It's hard to generalize these findings to all eaters everywhere when one only has 2 subjects in one's experiment. However, the investigators concluded:

Our observations suggest that successful speed eaters expand the stomach to form an enormous flaccid sac capable of accommodating huge amounts of food.

What happens to competitive speed eaters after years of gorging? We really don't know. No one has done long-term follow-up of eating champs, so educated guesses are all we currently have. The current scientific gut feeling is that digestive divas may have some problems awaiting them down the line.

We speculate that professional speed eaters eventually may develop morbid obesity, profound gastroparesis, intractable nausea and vomiting, and even the need for a gastrectomy. Despite its growing popularity, competitive speed eating is a potentially self-destructive form of behavior.

The closest I'll ever come to this degree of gastric overdistention occurred at a major radiology meeting about 20 years ago. My brother and I were invited to a wonderful French restaurant by some film manufacturers who wanted to buy our souls. We sold out to the triple whammy of food that was expensive, paid for by somebody else, and absolutely delicious. It was so delicious that we both ate way, way too much of it. By the time the satiety signal from our stomachs reached our brains, we were already a bit uncomfortable. By the time we got back to our hotel room, we felt too distended to breathe while lying down. Therefore, we sat up in bed, propped up by many pillows, and watched TV for a few hours until we had digested enough to get to sleep.

As luck would have it, the first thing that popped up on our TV happened to be Monty Python's The Meaning of Life. The movie was already in progress, somewhere in a scene where the Crimson Permanent Assurance briefly attempts to take over the film. "This looks entertaining", we thought. Just The Thing to occupy our minds during a few hours of gastric emptying.

Sometimes karmic payback is swift and sure. One of the next skits in the movie was the infamous encounter between Mr. Creosote and the "wafer-thin mint". You can imagine our mounting horror as that scene played out...

We do follow a lot of swallowed objects in patients, but it's usually a one-way trip in most folks. I've followed coins and toys in kids, and all sorts of bizarre objects (needles, safety pins, razor blades, etc.) in crazy people.

Hard to tell how the IFOCE feels about this -- their site doesn't give any details about what they consider proper safety measures, other than contestants should be over 18 and that an EMT should be standing by during a contest.

As a radiologist, I'm a bit out of loop on just which GI drugs might affect a supereater's performance. However, it's fun to speculate on the possible effect of drugs that relax the esophagus or stomach or that increase gastric emptying.

About Not Totally Rad

What does a radiologist do? Who are these rarely glimpsed and mysterious figures that float through the background of medical care?

Why would someone want to spend all of that time in medical school learning to be a Real Doctor™, and then throw it all away by becoming a radiologist?

Welcome to Not Totally Rad.

As the masthead suggests, most, but not all, of the topics discussed here will have something to do with radiology, medical imaging and imagers. Hopefully light will be shed on these matters, even if it's invisible to the naked eye.

About

The Samurai Radiologist has spent more than 20 years as a diagnostic radiologist, most of them professing at various university medical centers.
The "samurai" part is a nod to the late, great John Belushi, whose samurai skits on Saturday Night Live featured a samurai with a day job in some other field, such as dry-cleaning or a delicatessen. The plot usually gave him some hilarious job-related excuse to use his sword.
Since much of medical imaging (e.g. CT and MR) involves digital "cuts" through the body in various planes, I always hoped to someday see him portray a "samurai radiologist". I guess I'll just have to play that role myself.